Welcome to the Medicaid Policy Panel

Introduction to Policy 101- An AMA Primer

Medicaid Policy Panel

Welcome to the Medicaid

Policy Panel



Welcome to the Medicaid Policy Panel

Adult Medicaid Quiz

(or…What you hoped you would never need to know about Adult Medicaid)



As you know, the recently completed Medicaid case review revealed several areas where we could

improve. During the course of this meeting, we will be addressing these

areas, but first, we want to find out what we may (or may not) know

about policy in these areas.



The following questions are taken from our Adult Medicaid Basic

Training pre/post tests, as well as questions that relate to the Medicaid

review itself.



Don’t sweat this test!

It’s designed to give you some points to ponder and to give us some talking points. It will also challenge what you may believe regarding this policy and

review findings.



Let others take the test as well!

When you get back home, you can access the PowerPoint version of this test. You can use it as a training tool

for your staff. The test is located under the Learning Sessions area of the Adult Medicaid web site located

at http://www.training.eku.edu/adultmedicaid/learningsessions.htm



Question #1

Place in order (from most error-prone to least), the following causes of errors during the recent Medicaid

review

•Income Eligibility•Pass-Through Eligibility•Resources (Burial issues)•On-going ineligibles



And the Answer Is

Place in order (from most error-prone to least), the following causes of errors during the recent Medicaid

review•Resources (Burial issues)•On-going ineligibles•Pass-Through Eligibility•Income Eligibility



Question #2

Which of the following are technical eligibility factors that must be met in order to meet

requirements for Long Term Care? Check all that apply:

A. Resides in a nursing facility listed on KAMES InquiryB. Aged, Blind or DisabledC. Enrolled in Part B of MedicareD. A resident of KentuckyE. Sign the MA 36F. A US citizen or qualified AlienG. Verification of shelter expensesH. EnumerationI. Third Party LiabilityJ. Knows someone in high places



And, the Answer Is

Which of the following are technical eligibility factors that must be met in order to meet

requirements for Long Term Care? Check all that apply:

B. Aged, Blind or DisabledD. A resident of KentuckyF. A US citizen or qualified AlienH. EnumerationI. Third Party Liability



Question #3

Which of the following are “Excluded Resources” for AMA? Check all that apply:

A. Term and burial InsuranceB. Homestead property during the first six months of continuous institutionalizationC. Homestead property after the first six months of continuous institutionalization, when the spouse resides at the propertyD. Nursing home savings accountE. One vehicle, if used for employment, to obtain medical treatment, or is equipped for the disabledF. Two vehicles, one used for medical transportation, and one used for employmentG. All resources of an SSI individualH. Gravesites, crypts, caskets, and headstonesI. $1,500 burial exclusion for each member of the assistance group



And, the Answer Is

Which of the following are “Excluded Resources” for AMA? Check all that apply:

A. Term and burial InsuranceB. Homestead property during the first six months of continuous institutionalizationC. Homestead property after the first six months of continuous institutionalization, when the spouse resides at the propertyE. One vehicle, if used for employment, to obtain medical treatment, or is equipped for the disabledG. All resources of an SSI individualH. Gravesites, crypts, caskets, and headstonesI. $1,500 burial exclusion for each member of the assistance group



Question #4

Wendy Frost has made application for HCBS. She has a fully funded irrevocable funeral contract in the amount of $5,500. The itemized contract shows that $4,700 of the $5,500 contract is for excludable burial items. She also

has two life insurance policies. Policy A has a FV of $5,000 and CSV of $1,235. Policy B has a FV of $4,000

and a CSV of $921. A signed MA-36 is in the case record. What is the amount that should be added to her other

resources to be compared to the Resource Scale?

A. $2,156 C. $2956

B. $0 D. $2,056



And the Answer is

Since Wendy already had a fully funded funeral contract, she is not allowed to designate her life insurance policies as burial reserves. Therefore, the CSV of all the policies has to be considered

as a regular resource.

A. $2,156



Question #5

Which of the following are technically eligible for the Pass Through Category?

A. Individual lost SSI, but received at least one SSI check and one RSDI check in the same month correctly B. Individual received SSI due to disability as a child and lost SSI due to entitlement to or increase in RSDI DAC receipt C. Individuals who were disabled as a child and later recovered D. Individuals, ages 60-64, who lost SSI or SSP as a result of entitlement to RSDI early widow's or widower's benefits, and who are not yet entitled to Medi care Part A E. Individuals who received SSI and a private pension in the same month F. Individuals who received SSI or SSP and who lost SSI or SSP as a result of entitlement to RSDI disabled widow's or widower's or disabled surviving divorced spouse's benefits, and are not yet entitled to Medicare Part A.



And the Answer Is

Which of the following are technically eligible for the Pass Through Category?

A. Individual lost SSI, but received at least one SSI check and one RSDI check in the same month correctlyB. Individual received SSI due to disability as a child and lost SSI due to entitlement to or increase in RSDI DAC receiptD. Individuals, ages 60-64, who lost SSI or SSP as a result of entitlement to RSDI early widow's or widower's benefits, and who are not yet entitled to Medi care Part AF. Individuals who received SSI or SSP and who lost SSI or SSP as a result of entitlement to RSDI disabled widow's or widower's or disabled surviving divorced spouse's benefits, and are not yet entitled to Medicare Part A.



Question #6

Which type of case would best suit the following?

A. Lost their SSI due to a COLA increase in their RSDIB. Has Medicare A & B with countable income of $700 and no

medical billsC.Has Medicare A & B, lives alone in home, countable income

of $1345, has medical bill from prior month of $3000D.Has Medicare A & B, lives alone in home, gross income of

$600, pays a neighbor to cook meals and sort medicines daily



And the Answer Is

Which type of case would best suit the following?

A. Lost their SSI due to a COLA increase in their RSDI Pass-through (F,G,H)B. Has Medicare A & B with countable income of $700 and no

medical bills QMB (Z Case)C. Has Medicare A & B, lives alone in home, countable income

of $1345, has medical bill from prior month of $3000 Spend Down (J,K,M)D. Has Medicare A & B, lives alone in home, gross income of

$600, pays a neighbor to cook meals and sort medicines daily

SSP (FP, GP, HP)



Question #7

State Supplementation

Samantha is single and lives in a Family Care Home. Her only income is $632 monthly from RSDI based upon her disability. If eligible for State Supp. What

would the amount of her grant be?

A.$149B.$179C.$163D.$159



And, the Answer Is

State Supplementation

Samantha is single and lives in a Family Care Home. Her only income is $632 monthly from RSDI based upon her disability. If eligible for State Supp. What

would the amount of her grant be?

C. $163$795 Family Care home (includes $40 PNA)

-632 monthly income

$163 Monthly SSP Grant



Question #8

Determine the amount of excess burial reserves:

Mary Jones is a resident of an approved nursing facility. She has 3 life insurance policies and no funeral contract for burial. She has signed a MA-36 to designate all three

policies for burial. Policy A – FV = $2500 CSV = $900

Policy B – FV = $1500 CSV = $236

Policy C – FV = $1500 CSV = $726

What is the amount of the excess burial reserve?

A. $362 B. $4000C. $0 D. $1500



And the Answer Is

Determine the amount of excess burial reserves:

Mary Jones is a resident of an approved nursing facility. She has 3 life insurance policies and no funeral contract for burial. She has signed a MA-36 to designate all three

policies for burial. Policy A – FV = $2500 CSV = $900

Policy B – FV = $1500 CSV = $236

Policy C – FV = $1500 CSV = $726

What is the amount of the excess burial reserve?

A. $362

Policy A – FV = $2500 CSV = $900Policy B – FV = $1500 CSV = $236Policy C – FV = $1500 CSV = $726

Total $1862

- 1500

Excess 362



Question #9

Determine the total amount of resources:

Susan Jones has been admitted to a Medicaid approved nursing facility. Her representative has provided verification of the following for Ms. Jones:

Checking Account of $429 Savings Account of $682;

Nursing Facility Account of $110

Prearranged funeral contract of $6,000 that is funded by a life insurance policy of $6,000 that has an irrevocable assignment of ownership to the funeral home. Excludable burial space items included in the funeral contract total $4,000.

A. $7221 B. $1221C. $0 D. $3221



And the Answer Is

Determine the total amount of resources:

Susan Jones has been admitted to a Medicaid approved nursing facility. Her representative has provided verification of the following for Ms. Jones:

Checking Account of $429 Savings Account of $682;

Nursing Facility Account of $110

Prearranged funeral contract of $6,000 that is funded by a life insurance policy of $6,000 that has an irrevocable assignment of ownership to the funeral home. Excludable burial space items included in the funeral contract total $4,000.

B. $1221

Since there is an irrevocable assignment of Ownership (rather than the Funeral Home being the “Beneficiary”) of the life insurance policy that funds the prearranged funeral contract, none of that insurance policy will be considered as a resource. The total of the other assets:

$429 + $682 + $110 = $1,221



Question #10

Determine Patient Liability:

Bob Mac is 70 years old, lives alone and has been certified eligible for HCBS level of care. He has the following income: $728 from RSDI; $428 from a private pension; and $43 in monthly interest. He pays $93.50 for SMI premiums and $86.30 per month for health insurance. How much will he have to pay toward his own care (Patient Liability)?

A. $992 B. $794C. $333 D. $952



And the Answer Is

Determine Patient Liability:

Bob Mac is 70 years old, lives alone and has been certified eligible for HCBS level of care. He has the following

income: $728 from RSDI; $428 from a private pension; and $43 in monthly interest. He pays $78.20 for SMI premiums and $86.30 per month for health insurance. How much will

he have to pay toward his own care (Patient Liability)?

C. $333

Mr. Mac’s gross income:

$728 (RSDI) + $428 (pension) = $1,156. (Interest income is excluded.) His deductions are: $93.50 (SMI) + $86.30 (health insurance) + $643 (Personal Needs Allowance) = $822.80. $1,156 - $822.80 = $333.20, which rounds up to $333.



Question #11

Pass Through:

If a Pass Through applicant lost his/her SSI eligibility for any reason other than a COLA, what must happen in order to meet the Pass Through technical eligibility

requirement? A. He/she must reapply for SSI B. He/she must go through two COLA’s C. He/she must verify the reason the SSI

was discontinued D. He/she must go through at least one

COLA E. He/she cannot be eligible for the Pass

Through Program



And the Answer Is

Pass Through:

If a Pass Through applicant lost his/her SSI eligibility for any reason other than a COLA, what must happen in order to meet the Pass Through technical eligibility

requirement? D. He/she must go through at least

one COLA



Question #12

Estate Recovery:

Estate Recovery applies to individuals over 55 who receive MA for: (Check all that apply)

A. Nursing Facility, excluding institutionalized Hospice

B. Spenddown

C. ICF/MR/DDD. Supports for Community Living E. Non-Institutionalized HospiceF. Home and Community Based Services



And the Answer Is

Estate Recovery:

Estate Recovery applies to individuals over 55 who receive MA for: (Check all that apply)

A. Nursing Facility, excluding institutionalized Hospice

C. ICF/MR/DDD. Supports for Community Living F. Home and Community Based

Services



Test Scoring

All 12 Correct – Too Much Time on Your Hands

8-11 Correct – Above Average (Please stay!!!)

4-7 Correct – About average Good job!

0-3 Correct – Don’t feel too bad… THIS STUFF IS HARD!!!!!!

Welcome to the Medicaid Policy Panel

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